Bate multiple choice questions

1. ■ Multiple Choice
Choose the single best answer.
1. What is the preferred order for examination of the abdomen?
(A) Inspection, auscultation, percussion, palpation
(B) Percussion, auscultation, palpation, inspection
(C) Auscultation, inspection, palpation, percussion
(D) Inspection, palpation, auscultation, percussion
2. You are in the emergency room assessing a patient with abdominal pain and
fever. You are performing an abdominal examination to assess for peritoneal
signs. Which one of the following is NOT a peritoneal sign?
(A) Rebound tenderness
(B) Involuntary guarding
(C) Rigidity of the abdomen
(D) Voluntary guarding
3. A 15-year-old high school student presents to the clinic with a 1-day history of
nausea and anorexia. He describes the pain as generalized yesterday, but today
it has localized to the right lower quadrant. You palpate the left lower
quadrant and the patient experiences pain in the right lower quadrant. What is
the name of this sign?
(A) Psoas sign
(B) Obturator sign
(C) Rovsing’ sign
(D) Cutaneous hyperesthesia
4. A 25-year-old veterinarian presents to the clinic for evaluation of flank pain,
dysuria, nausea, and fever. A urine pregnancy test is negative. A urine dipstick
is positive for leukocyte esterase. On physical examination, what would be the
most likely sign expected?
(A) Psoas sign
(B) CVA tenderness
(C) Rovsing’ sign
(D) Murphy’ sign
5. A 40-year-old flight attendant presents to your office for evaluation of
abdominal pain. It is worse after eating, especially if she has a meal that is
spicy or high in fat. She has tried over-the-counter antacids, but they have not
helped the pain. After examining her abdomen, you strongly suspect
cholecystitis. Which sign on examination increases your suspicion for this
diagnosis?
(A) Psoas sign
(B) Rovsing’ sign
(C) Murphy’ sign
(D) Grey Turner’ sign
6. A 25-year-old celebrity with a known history of intravenous drug use presents
to the emergency room for evaluation of a 5-day history of nausea, emesis, and
right-upper-quadrant abdominal pain. On general survey, he appears ill and his
skin is distinctly yellow. He has a temperature of 102.5°F and a heart rate of
112 bpm. You provisionally diagnose him with acute hepatitis. What would
you expect to find on abdominal examination?
(A) Liver edge is tender and 4 to 5 finger-breadths below the RCM
(B) Liver edge is nonpalpable
(C) Liver edge is tender and 1 finger-breadth below the RCM
(D) Liver edge is nontender and 4 to 5 finger-breadths below the RCM

2. Chapter 10
Male Genitalia and Hernias
1. When performing a genitourinary assessment, you note that the urethral meatus is positioned
ventrally. This is most likely to be:
(A) A stricture
(B) Hypospadius
(C) The result of a circumcision
(D) Related to the aging process
2. When performing a genitourinary assessment on an adolescent male you notice a swelling in
the scrotum, which increases with increased intraabdominal pressure and decreases when lying
down. The young man complains of pain when straining. This history best describes:
(A) An incisional hernia
(B) A direct inguinal hernia
(C) An indirect inguinal hernia
(D) A femoral hernia
3. The following finding is considered normal when assessing an aging male:
(A) A decrease in scrotal color
(B) Enlargement of the testes and scrotum
(C) A decrease in the size of the penis
(D) The presence of a hydrocele, or fluid in the scrotum
4. When instructing patients about how to perform a testicular self-exam, which of the following
statements is most correct:
(A) “A good time to examine your testicles is just before you take a shower.”
(B) “Perform the testicular exam at least once a week to detect the early stages of cancer.”
(C) “The testicle should feel firm and has a lumpy consistency, be movable, and shaped like an
egg.”
(D) “If you notice any change from what you normally see or feel, call your health care provider.”
5. Which of the findings is a normal finding when examining the glands?
(A) The skin is wrinkled and without lesions
(B) The dorsal vein may be visible
(C) Smegma may be present under the foreskin of an uncircumcised male
(D) There is no hair
6. Which of the following statements is true when performing a male genital examination?
(A) Auscultate for the presence of bowel sounds over the scrotum in all males
(B) Palpate for the vertical chain of lymph nodes along the groin inferior to the inguinal ligament
(C) Palpate the inguinal canal only if there is a bulge present in the inguinal region during
inspection
(D) When palpating for a hernia on the right side, have the client shift his standing weight onto
the left leg

3. Chapter 11
Female Genitalia
Multiple Choice
1. When observing the vestibule, you should be able to see which of the following anatomic
structures?
(A) Urethral meatus and paraurethral (Skene’s) glands
(B) Vaginal orifice and vestibular (Bartholin’s) glands
(C) Urethral meatus and vaginal orifice
(D) Paraurethral (Skene’s) and vestibular (Bartholin’s) glands
2. To correctly insert the speculum:
(A) Instruct the woman to bear down, open the speculum blades and apply in a swift upward
movement
(B) Press the inferior margin of the introitus down to enlarge the vaginal opening, open, insert
the speculum with the blades at an oblique downward angle, and apply gentle downward
pressure
(C) Insert the blades of the speculum on a horizontal plane, turning them to a 45° angle as
you continue to insert them; ask the woman to bear down to ease insertion
(D) Lock the blades open by turning the thumbscrew. Once you have them open, apply
pressure to the introitus and insert the blades at a 45° angle downward to bring the cervix
into view
3. In performing the bimanual examination, you note that the cervix feels smooth and firm,
is round, and is fixed. Your cervical palpation produces some pain. The best
interpretation of these results is:
(A) These findings are well within normal limits
(B) It is unusual to have pain when palpating the cervix, but the rest of the findings are within
normal limits
(C) The cervix should move when palpated; an immobile cervix may indicate malignancy
(D) The cervical consistency should be soft and velvety and not firm
Mutiple Choice
1. Correct instructions about the self-breast examination (BSE) are:
(A) Tell the woman that the best time to perform BSE is in the middle of the menstrual cycle
(B) Recommend that the best time to perform BSE is 4–7 days after the first day of the
menstrual period
(C) Tell the woman that if she is pregnant, she should not perform BSE until the baby is born
(D) Urge the woman that she needs to do BSE bimonthly unless she has fibrocystic breast
tissue
2. You have just completed a vaginal examination of a woman who is 6 weeks pregnant. You
read on her chart that her cervix is softened and looks cyanotic. You know that she is exhibiting
which of the following signs?

4. (A) Chadwick’s sign and Hegar’s sign
(B) Goodell’s sign and Chadwick’s sign
(C) Hegar’s sign and Goodell’s sign
(D) Tanner’s sign and Hegar’s sign
3. During your examination of a woman in her second trimester of pregnancy, you note the
presence of a small amount of yellow drainage from the nipples. You know that this is:
(A) Most likely to be colostrum and considered a normal finding this late in her pregnancy
(B) A sign of breast cancer
(C) Too early in the pregnancy for lactation to begin; the woman needs a referral to a
specialist
(D) An indication that the woman’s milk is forming
4. When palpating the fundus, you know that:
(A) Fundal height is usually less than the number of weeks gestation, unless there is an
abnormal condition such as too much amniotic fluid present
(B) The fundus should be hard and slightly tender to palpation during the first trimester
(C) After 20 weeks gestation, the number of centimeters should approximate the number of
weeks gestation
(D) Fetal movement should be felt by the examiner at the beginning of the second trimester
5. You are palpating the abdomen of a 35-week pregnant woman and note that the fetal head is
facing downward toward the pelvis. You would document this as:
(A) Fetal lie
(B) Fetal presentation
(C) Fetal attitude
(D) Fetal variety
The Anus, Rectum, and Prostate
Multiple Choice
1. A 28-year-old bus driver presents to the emergency room for pain and drainage from an area
at the bottom of her spine. This has never occurred before. On examination of the rectum, a
small opening is identified in the midline superficial to the lower sacrum. There is a
surrounding halo of erythema. It is tender to palpation and purulent material is expressed.
Your most likely diagnosis of this condition is?
(A) Anorectal fistula
(B) Pilonidal cyst
(C) Anal fissure
(D) Thrombosed external hemorrhoid
2. A 24-year-old housewife and mother presents to the clinic for evaluation of rectal bleeding.
She has intermittent constipation and frequently has to use a laxative to have a bowel movement.
On examination of the anus, you see a reddish, moist, protruding mass located at the 5 o’clock
position. What is your most likely diagnosis?
(A) Hemorrhoid
(B) Internal hemorrhoid
(C) External rectal prolapse
(D) Rectal polyp
3. A 35-year-old accountant presents to the clinic for evaluation of sudden onset of pain in his
rectum. On examination of the anus, you see a swollen, bluish, ovoid mass at the anal margin,

5. located at the 8 o’clock position. What is your most likely diagnosis?
(A) External hemorrhoid
(B) Internal hemorrhoid
(C) Rectal prolapse
(D) Rectal polyp
4. A 32-year-old farmer presents to the clinic for evaluation of pain with defecation as well as
rectal bleeding. His family history is negative for inflammatory diseases of the bowel and for
colon cancer. On physical examination, there is a swollen skin tag, and, with gentle separation of
the anal margin, a thin line of ulceration is visible. What is your most likely diagnosis?
(A) Pilonidal cyst
(B) Anorectal fistula
(C) External thrombosed hemorrhoid
(D) Anal fissure
5. A 65-year-old gardener presents to the office for difficulty with urination. Increasingly, he has
noticed feeling like his bladder has not emptied completely and his urinary stream has a
decreased force. He experiences dribbling after he completes urination. These symptoms have
been going on for several years, but his level of discomfort has increased over the past few
months. On physical examination, you feel a symmetrically enlarged, smooth, and firm prostate
gland, which seems to protrude more into the rectal lumen without any discrete lesions. What is
your most likely diagnosis?
(A) Normal prostate
(B) Prostatitis
(C) Benign prostatic hyperplasia
(D) Prostate cancer
6. A 36-year-old computer programmer presents to the office with pain with urination, and fever.
On palpation of the prostate, his gland is swollen, tender, and warm to the touch. Your most
likely diagnosis is?
(A) Normal prostate
(B) Benign prostatic hyperplasia
(C) Prostate cancer
(D) Prostatitis
The Musculoskeletal System
Multiple Choice
1. A 42-year-old female office worker presents to your clinic complaining of awakening with an
exquisitely tender, red, swollen right knee. She has never had this occur before and has had no
history of trauma or recent illness. She has no significant past medical history. A family history
reveals that her father had similar problems in middle age. On exam, she has a red, warm,
tender right knee with decreased range of motion. Tapping the fluid in the knee showed no signs
of infection indicating a probable arthritic cause. The most likely form of arthritis would be:
(A) Rheumatoid arthritis
(B) Degenerative joint disease
(C) Gouty arthritis
(D) Polymyalgia rheumatica
2. A 54-year-old woman who works at a dry cleaners presents to your office complaining that she
cannot do overhead work with her right arm. She states that she can no longer lift her arm over
her head without using her other arm to prop it up. She remembers no specific injury but has
been doing overhead work at the dry cleaners for over 15 years. Her past medical history is

6. significant for three spontaneous vaginal deliveries and 15 years of hypertension. On exam, she
has demonstrative weakness with internal and external rotation on the right. When she attempts
to abduct her arm, there is obvious shrugging of the shoulder. On inspection of her back, you
note atrophy of the muscles surrounding the shoulder and scapula. She is nontender over any
boney prominence in the shoulder. Her passive range of motion is normal, while on active range
of motion she is unable to elevate her arm more than 12 inches and cannot raise it to shoulder
level. What shoulder problem is the most likely diagnosis?
(A) Rotator cuff tendonitis
(B) Bicipital tendonitis
(C) Acrominoclavicular arthritis
(D) Rotator cuff tear
3. A 13-year-old boy is brought into the urgent care clinic by his father with a complaint of swelling
around his right elbow. He is in 8th grade football and has been lifting weights, despite having just
started puberty. He has no significant past medical history and recalls no specific incident of
trauma to the elbow. On exam, the patient has a soft swelling around the posterior of the elbow.
He has no redness or warmth and minimal pain. He is nontender over the bony prominences of
the ulna, radial head, and humorous. What disorder of the elbow is the most likely diagnosis?
(A) Arthritis
(B) Olecranon bursitis
(C) Epicondylitis
(D) Rheumatoid nodules
4. A 28-year-old male waiter presents to your office complaining of a growth on the back of his left
hand. He states it started slowly months ago but has now enlarged enough to be embarrassing.
He states it only hurts when he is holding a tray of food up in the air with his left hand. He has no
significant past medical history and no one else in the family has this problem. On exam, you
note a 2-cm round cystic-like lesion on the dorsum of his left wrist over the carpals. It is more
prominent when he flexes his wrist. What is the most likely cause of his hand swelling?
(A) Ganglion
(B) Chronic tophaceous gout
(C) Acute rheumatoid arthritis
(D) Heberden’s nodes
5. A 32-year-old attorney comes to your clinic complaining of severe neck pain when he tries to
turn his head to the right. He reports to you that he was the restrained driver in a MVA the day
before, when he was hit from behind at approximately 40 mph. He states he did not hit his head
and he did not lose consciousness. He refused to be evaluated by EMS at the scene. He states
he felt okay after the accident but today woke up in extreme pain. He is having no numbness or
tingling in his right hand and states he has no problems holding a pen. He has no symptoms
below the neck. He has no significant past medical history. On exam, he has difficulty turning
his head to the right or tilting it to the right. He also has difficulty with extending his head. He is
able to flex his neck and turn and tilt to the left. On palpation, he is tender over the right trapezius
and rhomboid muscles. He has no tenderness along the cervical vertebrae or the clavicle or
scapula. He has normal reflexes in his biceps, triceps, and brachioradialis. He has normal
strength in his elbow and wrist and has normal two-point discrimination. Having the patient
cough does not increase his symptoms. What type of neck pain best describes his problem?
(A) Cervical sprain
(B) Muscle ache
(C) Neck pain with dermatomal radiation
(D) Neck pain from cervical spinal stenosis
6. An 85-year-old retired secretary presents to your office complaining of severe lower back pain.
She states that it started 4–5 months ago and has gradually been getting worse. She takes
Daypro for arthritis but that hasn’t helped her very much. She says that lying down or sleeping
does not seem to help. She doesn’t recall any trauma to her back. She has had no unusual
problems with strength in her legs or bowel or bladder control. Her past medical history is

7. significant for 30 years of hypertension and right-sided breast cancer 10 years ago. She had a
mastectomy and radiation therapy. She did not take any chemotherapy. She denies tobacco or
alcohol use. On exam, you find a thin, cachectic-appearing woman in no acute distress. Her
heart and lung exam are normal. She is tender over the L4 and L5 vertebrae. She has normal
sensation, strength, and reflexes in her lower extremities. She is nontender over the para spinal
muscles around the lumbar region and has a negative straight leg rise bilaterally.
(A) Mechanical low back pain
(B) Radicular back pain
(C) Back pain from metastatic disease
(D) Spinal stenosis
MULTIPLE CHOICE
1. A patient complains of shortness of breath and productive cough. Consolidation is present in
the lungs if you find:
(A) Dullness to percussion over left base
(B) Bronchial breath sounds throughout
(C) Increased tactile fremitus throughout
(D) Inspiratory and expiratory wheezes
2. Which of the following is the best technique for assessing the supraclavicular lymph nodes?
(A) Place the patient in a supine position and ask him to hold his breath while you palpate
(B) Place the patient in Trendelenburg position and illuminate the nodes with a bright light
(C) Standing behind the patient, palpate deeply behind the clavicles as he takes a deep
breath
(D) Palpate lightly below the clavicles with the patient in a sitting position
3. The examiner notes an abnormally high diaphragm on the right side and descent of 4 cm on
the left side. These findings suggest:
(A) The patient may have a pleural effusion
(B) The patient may have right middle lobe pneumonia
(C) Asymmetrical findings, which are common in well-conditioned adults
(D) A normal finding because the right lung is larger than the left lung
4. The following findings indicate a possible pulmonary abscess:
(A) Malodorous breath
(B) Protrusion of the clavicle
(C) Clubbing of the nail beds
(D) Kussmaul respirations
5. The patient has an undiagnosed tumor in the middle lobe of the right lung, causing atelectasis,
as suggested by
(A) Low-pitched grating sound heard during inspiration and expiration
(B) Hyperresonance in the right middle lobe
(C) Diminished or absent breath sounds in the right middle lobe
(D) An ammonia-like odor on the patient’s breath
6. While auscultating the lungs of an obese patient, you would expect the heart sounds to be:
(A) Louder and closer
(B) Softer and more distant
(C) Louder and more distant
(D) Softer and closer
7. To rule out a middle lobe pneumonia, you must make sure to auscultate:
(A) Beneath the right breast

8. (B) Beneath the left breast
(C) Under the right axilla
(D) Under the left axilla
8. When percussing normal lungs, the expected percussion note would be:
(A) Resonance
(B) Tympany
(C) Dullness
(D) Stridor
9. Expected findings in the healthy adult lung include the presence of:
(A) Increased tactile fremitus and dull percussion tones
(B) Adventitious sounds and limited chest expansion
(C) Muffled voice sounds and symmetrical tactile fremitus
(D) Absent voice sounds and hyperresonant percussion tones
10. Dullness on percussion over the left lower lobe of the lung is most likely to reflect:
(A) Consolidation
(B) Asthma
(C) Chronic obstructive pulmonary disease
(D) Excess adipose tissue
11. The most important technique when progressing from one auscultory site on the thorax to
another is:
(A) Top-to-bottom comparison
(B) Side-to-side comparison
(C) Posterior-to-anterior comparison
(D) Interspace-by-interspace comparison
12. When auscultating the chest in an adult, you would:
(A) Use the bell of the stethoscope held lightly against the chest to avoid friction
(B) Use the diaphragm of the stethoscope held firmly against the chest
(C) Instruct the client to breathe in and out through her nose
(D) Instruct the patient to take deep, rapid breaths
13. Decreased breath sounds would be most likely to occur:
(A) When the bronchial tree is obstructed
(B) When adventitious sounds are present
(C) In conditions of hyperresonance like COPD
(D) In conjunction with whispered pectoriloquy
14. A patient presents with an area of dullness to percussion and breath sounds that are
decreased to absent, suggesting the following diagnosis:
(A) Pneumothorax
(B) COPD (emphysema)
(C) Pleural effusion
(D) Asthma
15. A teenage boy presents to the emergency room with complaints of sharp pain and trouble
breathing. You find that the patient has cyanosis, tachypnea, tracheal deviation to the right,
decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds
on the left. This is consistent with:
(A) Acute pneumonia
(B) An asthmatic attack
(C) Bronchitis
(D) A spontaneous pneumothorax

9. 16. Tachypnea, use of accessory muscles, prolonged expiration, intercostal retraction, decreased
breath sounds, and expiratory wheezes are all symptomatic of:
(A) Pleural effusion
(B) Atelectasis
(C) Asthma
(D) Bronchitis
17. Air passing through narrowed bronchioles would produce which of the following adventitious
sounds:
(A) Whispered pectoriloquy
(B) Wheezes
(C) Bronchophony
(D) Muffled breath sounds
18. The primary muscles of respiration include the:
(A) Diaphragm and intercostals
(B) Trapezius and rectus abdominus
(C) Sternomastoids and scalenes
(D) External obliques and pectoralis major
The Breast
Multiple Choice
1. A 21-year-old female presents to your clinic for her annual exam. She informs you that for the
last 3 months, she has felt a lump in her left breast above the nipple. She has had no discharge
from the nipple. Her past medical history is nonsignificant. She has not been sexually active and
is on no medication. She denies any tobacco, alcohol, or drug use. Her paternal grandmother
had breast cancer in her seventies and did well with surgery and radiation. On physical exam,
you feel a firm disc like lump at 12 o’clock on the left breast. It is easily delineated, mobile, and is
nontender. The patient only has shoddy nodes in the left axilla. There are no unusual skin
changes. The right breast and the remainder of her heart, lung, abdominal, and pelvic exam are
unremarkable. What form of breast mass is she most likely to have?
(A) Fibroadenoma
(B) Cysts
(C) Cancer
2. A 48-year-old homemaker comes to your office complaining of a breast lump she found under
her right arm while showering. She says it hasn’t been there during past checks and it doesn’t
hurt when she examined it. She admits she hadn’t done a self-breast exam in almost 1 year. She
states she has had three normal mammograms during the last 8 years. The last mammogram
was 18 months ago. Her past medical history is significant for one spontaneous vaginal delivery
at age 38. She went through menopause 3 years ago and is on estrogen and progesterone
replacement. She has smoked one pack of cigarettes daily for the past 25 years but denies any
alcohol or drug abuse. Past medical history reveals that her maternal aunt had breast cancer in
her thirties and her maternal grandmother had ovarian cancer in her seventies. Review of
systems is noncontributory. On exam, you feel a hard, approximately 2-cm lump in the tail of
Spence under the patient’s right arm. The lump is nontender, and you have difficulty finding the
borders. It is not adherent to anything, and you feel no lymphadenopathy in the axilla or
supraclavicular areas. The skin over the breast appears normal. Examination of the left breast is
unremarkable. What type of breast mass is the patient most likely to have?
(A) Fibroadenoma
(B) Cysts
(C) Cancer
3. A 31-year-old nurse presents to your office complaining about a painful lump in her right breast
next to the nipple. She states it has been there for several months and won’t go away. She

10. recently started taking birth control pills after remarrying. Her past medical history is significant
for asthma and two spontaneous vaginal deliveries. Family history reveals no breast or ovarian
disorders. She denies any tobacco or drug use and drinks alcohol socially. On exam, you feel a
1-cm lump medial to her areola. It is round soft and very tender. There are no skin retractions
and no palpable lymph nodes in the axilla. Her left breast also has a ½-cm soft lump medial to
the areola that is not quite as tender. The patient states she hadn’t noticed that area before.
What type of breast mass is the most likely cause of her pain?
(A) Fibroadenoma
(B) Cysts
(C) Cancer
4. A 22-year-old woman comes to your office complaining of a white discharge from her breasts,
which has been occurring for 2 months. She also states that she hasn’t had her period in 6
months. She denies any chance of pregnancy since she hasn’t been sexually active in over 1
year. She is on no medications except a multivitamin. Her past medical history is significant for
allergies only. Past medical history reveals a mother with cystic breasts and a great aunt with
breast cancer. Review of systems is noncontributory. On exam, her breasts are symmetrical,
with no skin changes. You are able to express milky discharge from each nipple. You feel no
discrete masses, and her axillae are normal. The remainder or her heart, lung, abdominal, and
pelvic exam are unremarkable. What cause of nipple discharge is the most likely in her
circumstance?
(A) Benign breast abnormality
(B) Breast cancer
(C) Nonpuerperal galactorrhea
5. A 76-year-old widow comes to your clinic to establish care. She admits that she hasn’t seen a
clinician in over 5 years, but her daughter has been nagging her to be seen. She states she has
noticed that an area to the outside of her left breast feels enlarged, and there are some different
changes to the skin in the area. Her past medical history is significant for two spontaneous
vaginal deliveries and diet-controlled diabetes. She denies any tobacco or drug use and no
alcohol abuse. Her review of systems is remarkable for a 10-pound weight loss in the last 6
months and some recent fatigue. On exam, you find an elderly woman appearing her stated age.
Inspection of her left breast reveals some thickening of the skin lateral to her areola, with
enlarged pores. You feel a nontender 5-cm mass. The axilla has at least two enlarged lymph
nodes, which are adherent to the underlying ribs. The right breast and axilla are unremarkable.
What visible skin change of the breast does she have?
(A) Nipple retraction
(B) Paget’s disease
(C) Peau d’orange signs